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RC1 83  .M58  1 882    Prevention  and  restr 


RECAP 


Michigan.  State  Board  of  Health. 
Prevention  and  Restriction  of 
wSmall-pox.  1862. 


Columbia  (Bnit^ensttp 

intljeCitpoflmlork 

CoUege  of  ^Ijpgictang  anb  ^urgeonsi 
Hibrarp 


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CO 

S  PREVENTION    AND   RESTRICTION   OF 

^  SMALL-POX. 


[54.] 

DOCUMENT   ISSUED  BY   THE   MICHIGAN   STATE    BOARD   OF 

HEALTH. 

(Edition  of  1832,-30,000  copies  reprinted;  from  the  Annual  Report  of  the  Board  for  1331.) 


PREVENTION    OF    SMALL-POX. 

1.  Small-pox  a  preventable  disease. — It  has  long  been  known  that  small-pox 
can  be  prevented  or  modified  by  vaccination.  It  is  now  believed  that  a  wide- 
spread epidemic  of  the  disease  can  be  attributed  only  to  an  equally  wide-spread 
ignorance  or  willfulness  concerning  small-pox  and  its  prevention  by  vaccina- 
tion.    No  intelligent  person  need  have  small-pox. 

2.  Why  vaccinate. — Because  unmodified  small-pox  is  so  deadly  a  disease, 
and  so  often  disfigures  and  enfeebles  those  who  recover,*  and  because  by  trav- 
eling or  by  travelers,  by  articles  received  in  the  mail  or  from  stores  or  shops, 
or  in  various  other  ways  any  one  at  any  time  may  without  knowing  it  be  exposed 
to  small-pox,  it  becomes  important  so  far  as  possible  without  injury  to  health 
to  render  every  person  incapable  of  taking  the  disease.  This  may  be  done  so 
perfectly  by  vaccination  and  revaccinatioii  with  genuine  bovine  vaccine  virus 
that  no  question  of  ordinary  expense  or  trouble  should  be  allowed  for  a  day  to 
prevent  the  careful  vaccination  of  every  man,  woman,  and  child  in  Michigan, 
and  the  revaccination  of  every  one  Avho  has  not  been  vaccinated  within  five 
years.  It  is  well  established  that  those  who  have  been  properly  vaccinated  are 
far  less  likely  to  take  small-pox  if  exposed  to  it,  and  that  the  very  few  who 
have  been  properly  vaccinated  and  have  small-pox  have  it  in  a  much  milder 
form  and  are  much  less  disfigured  by  it  than  those  who  have  not  been  thus 
vaccinated.     The  value  of  vaccination  is  illustrated  by  the  following  facts : — 

On  March  13,  1859,  Dr.  E.  M.  Snow,  of  Providence,  R.  I.,  found,  in  a 
cluster  of  seven  houses,  twenty-five  families,  and  in  these  families  ten  cases  of 
small-pox,  all  apparently  at  about  the  same  stage  of  the  disease.  In  the  same 
families  there  were  twenty-one  children  who  had  never  been  vaccinated.  The 
ten  cases  and  the  remaining  members  of  the  families  including  the  twenty-one 
children  were  quarantined  at  home,  and  the  children  were  all  vaccinated  and 
compelled  to  remain  with  the  sick.  Several  other  cases  of  small-pox  occurred 
in  persons  previously  exposed,  but  not  one  of  t^e  twenty-one  children  referred 
to  had  the  slightest  touch  of  the  disease. 

*  "Among  those  -who  outlive  it,  many  either  totally  or  ptirtially  lose  their  sight  or  hearing;  many 
are  left  consumptive,  weakly,  sickly,  or  maimed;  many  are  disligured  for  life  by  horrid  scars,  and 
become  shocking  objects  to  those  who  approach  them,  immense  numbers  lose  their  eyesight  by 
it.'"— ia  ConUa7ni)ic. 


2  PEEVENTION  OF   SMALL -POX. 

In  Sweden  the  average  number  of  deaths  in  each  year  from  small-pox  per 
one  million  inhabitants  was, — 

Before  the  introduction  of  vaccination  (1774-1801),  1,973. 

During  the  period  of  optional  vaccination  (1802-1816'),  479; 

And  during  the  period  of  obligatory  vaccination  (1817-1877),  189. 

Vaccination  was  introduced  in  England  near  the  beginning  of  the  present 
century,  and  since  1853  compulsory  vaccination  has  been  attempted.  In 
England  the  number  of  deaths  in  each  year  from  small-pox  per  one  million 
inhabitants  was, — 

At  the  close  of  the  last  century,  3,000; 

From  1841  to  1853  (average),  304; 

From  1854  to  1863  (average),  171. 

In  the  Bavarian  army  revaccination  has  been  compulsory  since  1843.  From 
that  date  till  1857,  not  even  a  single  case  of  unmodified  small-pox  occurred, 
nor  a  single  death  from  small-pox. 

During  43  years  of  duty,  Dr.  Marson,  physician  of  the  London  small-pox 
hospital,  has  never  observed  a  single  case  of  small-pox  in  the  officers  and 
employees  of  the  hospital,  who  are  revaccinated  when  they  enter  the  service, 
and  who  are  constantly  exposed  to  the  infection. 

''Out  of  more  than  10,000  children  vaccinated  at  Brussels  with  animal 
lymph,  from  1865  to  1870,  and  who  went  through  the  terrible  epidemic  of 
small-pox  which  in  1870  and  1871  frightened  the  world,  not  a  single  one  was, 
to  my  knowledge,  reported  as  being  attacked  by  the  disease.  The  same  immu- 
nity was  shared  by  those — a  much  larger  number — whom  I  had  revaccinated, 
and  who  at  the  same  time  were  living  in  epidemic  centers." — Dr.  Warlemont, 
of  Brussels. — [North  Carolina  MedicalJournal,  January,  1880.    Vol.  v.,  p.  2.] 

3.  Who  should  be  vaccinated — Everybody,  old  and  young,  for  his  own  inter- 
est and  that  he  may  not  become  a  breeding-place  for  the  distribution  of  small- 
pox to  others,  should  seek  that  protection  from  small-pox  which  is  afforded  by 
vaccination  alone.  Ic  is  believed  that  all  persons  except  those  mentioned  in 
the  following  paragraph  may,  if  the  operation  is  properly  performed,  at  the 
proper  time,  and  with  pure  bovine  virus,  be  vaccinated  with  perfect  safety  to 
themselves.  Even  those  who  have  had  small-pox  should  be  vaccinated,  for 
otherwise  they  may  take  the  disease;  and  it  seems  to  be  proved  that  a  larger 
proportion  of  those  who  have  small-pox  a  second  time  die  than  of  those  who 
have  the  disease  after  vaccination. 

4.  Who  should  not  be  vaccinated. — Unless  exposure  to  small-pox  is  believed  to 
have  taken  place,  or  likely  to  take  place,  teething  children,  pregnant  women, 
persons  suffering  with  measles,  scarlet  fever,  erysipelas,  or  susceptible  to  and 
recently  exposed  to  one  of  these  diseases,  persons  suffering  with  skin  disease  or 
eruption,  and  in  general  feeble  persons  not  in  good  health,  should  not  be  vac- 
cinated. In  all  cases  in  which  there  is  any  doubt  as  to  the  propriety  of  vaccin- 
ating or  postponing  vaccination,  the  judgment  of  a  good  physician  should  be 
taken.  The  restriction  as  to  vaccinating  teething  children  makes  it  important 
that  children  should  be  vaccinated  before  the  teething  process  has  begun, 
because  small-pox  is  very  much  more  dangerous  than  vaccination.  Small-pox 
is  exceedingly  dangerous  to  pregnant  women. 

5.  When  should  a  person  be  vaccinated. — The  sooner  the  better,  as  a  rule,  and 
especially  whenever  there  is  much  liability  of  exposure  to  small-pox.  Children 
should  be  vaccinated  before  they  are  four  months  old;  those  who  have  never 
been  vaccinated,  should,  with  the  exceptions  previously  made,  in  paragraph  4, 


VACCINE   VIRUS.  d 

be  vaccinated  at  once.  Because  the  vaccination  often  loses  its  protective  power 
after  a  time,  those  who  have  been  vacciiKited  but  once  or  twice  should,  in  order 
to  test  and  to  increase  the  protective  power  of  the  former  vaccination,  be 
vaccinated  again  and  as  often  as  the  vaccination  can  be  made  to  work.  For 
the  Grst  three  or  four  scars  tlie  protection  afforded  is  believed  to  be  somewhat 
in  proportion  to  tlie  number  of  good  scars,  conditioned  always  that  the  scars 
be  the  result  of  a  proper  vaccination  witli  genuine  vaccine  virus.  In  general, 
to  insure  full  protection  from  small-pox  one  should  be  vaccinated  as  often  as 
every  five  years.  It  has  been  found  that  of  those  who  have  small-pox,  the 
proportion  of  deaths  is  very  much  less  among  those  who  have  three  or  four 
good  vaccination  scars  tlian  among  those  who  have  but  one  scar. 

Vaccination  as  late  as  the  second  day  after  known  exposure  to  small-pox,  has 
prevented  the  small-pox;  vaccination  the  third  day  after  exposure  has  been 
know  to  render  the  disease  much  milder  than  usual,  and,  in  a  recent  case  in 
Iowa,  vaccination  on  the  seventh  or  eighth  day  after  exposure  to  small-pox  ran 
a  partial  course  and  was  believed  to  have  modified  the  attack  of  small-pox, 
which  however,  it  did  not  wholly  prevent. 

6.  "With  what  should  one  be  vaccinated. — Virus  taken  from  the  arm  of  one 
vaccinated  a  second  time  is  worthless  because  unreliable.  Virus  dissolved  and 
carried  about  between  glass  slips  in  the  pocket  of  the  vaccinator  is  liable  to 
contamination  and  fermentation;  bovine  virus  dried  on  ivory  or  quill  points  is 
preferable.  It  should  be  remembered  that  a  vaccination  which  does  not  pro- 
duce a  vaccine  vesicle,  wliile  it  affords  but  little  or  no  lasting  protection  against 
small-pox,  may  prevent  subsequent  vaccinations  from  working  well  and  becom- 
ing protective.  For  this  reason  it  is  important  to  use  only  virus  from  reliable 
sources  and  free  from  contamination  or  decomposition.  In  a  majority  of  cases, 
if  the  virus  be  taken  at  the  proper  time  (eighth  day  after  vaccination)  from 
the  arm  of  a  healthy  child  having  no  taint  of  a  hereditary  or  communicable 
disease,  such  as  scrofula,  consumption,  syphilis,  erysipelas,  scarlet  fever,  etc., 
and  undergoing  the.  action  of  its  first  vaccination,  and  if  a  properly  cleaned 
lancet  be  used,  no  harm  will  result  to  the  person  vaccinated,  and  a  good  vaccin- 
ation may  be  secured.  This  method  involves  rupturing  the  vesicle  on  the  arm 
of  the  child  from  whom  the  virus  is  obtained,  and  this  is  objectionable  because 
it  may  interfere  with  the  complete  development  of  its  vaccination.  But 
because  harm  has  sometimes  resulted  from  the  use  of  virus  taken  from  another 
person,  because  it  is  often  impossible  to  tell  whether  a  child  has  pure  blood  and 
is  free  from  every  disease,  because  it  is  so  easy  to  obtain  pure  and  fresh  bovine 
virus,  and  because  such  bovine  virus  is  efficient,  it  is  better  in  all  cases  to  use 
only  the  pure  and  fresh  bovine  virus. 

Reasons  for  preferring  bovine  virus  to  humanized  virus  may  be  given  as  fol- 
lows:— (l.j  By  the  use  of  the  bovine  virus  tliere  is  secured  a  more  perfect  or 
typical  development  of  the  vaccine  disease  ;  and  hence  it  may  fairly  be  inferred 
a  greater  protection  against  small-pox.  (2.)  With  the  bovine  virus  and  with 
a  clean  lancet,  and  with  clean  surroundings,  there  is  no  danger  of  communi- 
cating syphilis.  (3.)  The  bovine  virus  is  far  more  effective  than  the  human- 
ized virus  in  revaccination ;  and  where  the  humanized  virus  fails  and  the 
bovine  virus  works  it  is  probable  that  there  was  susceptibility  to  small-pox 
which  the  humanized  virus  did  not  remove  but  which  has  been  removed  by  the 
bovine  virus.  (4.)  Greater  care  can  be  taken  in  the  propagation  of  bovine 
virus,  a  greater  supply  can  bo  always  at  command,  and  always,  but  especially 
in  times  of  urgent  danger  from  small-pox  people  can  have  a  better  guarantee 
that  they  are  vaccinated  with  genuine  and  pure  vaccine  virus. 


4  PREVENTION   OF  SMALL -POX. 

7.  By  whom  should  one  be  vaccinated — The  operation  of  vaccination  should 
be  performed  always  by  a  competent  and  responsible  physician,  or  by  some  one 
whom  he  has  instructed  and  recommends  to  perform  the  operation.  To  try 
to  vaccinate  one's  self  or  one's  family  is  poor  economy,  for  it  often  results  not 
only  in  a  waste  of  money  and  of  time  but  in  a  false  and  dangerous  feeling  of 
security.  To  trust  to  vaccination  by  nurses  and  midwives  is  equally  foolish. 
A  well-educated  and  experienced  physician  has  the  skill,  and  the  special  knowl- 
edge necessary  to  the  best  judgment  on  all  of  the  questions  involved,  without 
which  the  operation  may  be  a  failure  or  worse  than  a  failure.  In  work  of 
this  kind  the  best  is  the  cheapest,  whatever  it  costs. 

8.  Where  to  obtain  fresh  and  pure  bovine  virus. — Dr.  E.  L.  Griffin,  of  Fond 
du  Lac,  Wis.,  by  a  series  of  inoculations  of  young  heifers  propagates  virus  of 
the  Belgian  stock  of  cow-pox,  obtained  from  Dr.  Warlomont,  director  of  the 
government  vaccine  establishment  of  Brussels.  This  virus,  so  far  as  known, 
never  has  passed  through  the  human  subject.  It  is  stored  on  ivory  points,  each 
of  which  holds  enough  virus  to  vaccinate  one  person,  and  should  be  used  only 
for  one  person.  Ten  points  are  sent  by  mail  for  one  dollar ;  and  if  used  accord- 
ing to  the  directions  of  Griffin's  circular  within  ten  days  of  the  receipt  of  the 
package  their  efficiency  is  guaranteed  by  him.  Dr.  Henry  A.  Martin,  of  27 
Dudley  St.,  Boston,  Mass.,  who  claims  the  honor  of  being  the  first  propagator 
of  bovine  virus  in  the  United  States,  propagates  virus  of  the  Beaugency  stock. 
Both  Dr.  Griffin  and  Dr.  Martin  are  believed  to  be  reliable  propagators  of 
bovine  vaccine  virus.  By  request  of  the  Michigan  State  Board  of  Health,  Dr. 
George  E.  Ranney,  of  Lansing,  Mich.,  supplies  to  persons  in  Michigan  order- 
ing through  him,  the  virus  propagated  by  Dr.  Griffin,  at  Dr.  Griffin's  prices, 
the  money  to  accompany  the  order. 

9.  "Where  should  vaccination  be  performed. — In  a  room  or  place  free  from  per- 
sons suffering  from  disease,  and  from  dust  or  vapors  which  may  convey  to  the 
scratched  surface  germs  of  any  communicable  disease;  certainly  not  in  or 
near  a  room  where  there  is  erysipelas,  nor  in  the  presence  of  one  who  has  just 
come  from  a  person  sick  with  erysipelas,  diphtheria,  or  scarlet  fever. 

10.  How  to  vaccinate. — In  remote  places  it  is  sometimes  necessary  to  vaccinate 
persons  who  are  practically  beyond  the  reach  of  a  competent  physician.  For 
the  benefit  of  such,  and  not  as  an  encouragement  to  others  to  dispense  with 
the  services  of  a  skillful  physician,  the  following  suggestions  are  made  as  to 
the  best  method  of  vaccinating.  As  a  rule  the  most  convenient  place  for  vac- 
cination is  found  to  be  on  the  outer  surface  of  the  left  arm,  about  one-half  or 
two-thirds  the  way  up  from  the  elbow  to  the  shoulder.  An  infant  which  its 
mother  carries  on  her  right  arm  should  be  vaccinated  on  its  right  arm  in  order 
to  avoid  rupturing  the  vesicle  by  pressure  against  its  mother.  With  a  sharp- 
pointed  and  perfectly  clean  instrument  (lancet)  make  six  parallel  scratches, 
barely  sufficient  to  make  a  show  of  blood,  but  not  to  cause  bleeding.  Directly 
across  these  scratches  make  four  or  five  similar  scratches,  so  that  the  scarified 
place  shall  be  as  large  as  a  split  pea,  and  something  like  this  illustration  :  ^^Sc 
If  blood  flows,  wait,  and  wipe  it  off  before  applying  the  lymph.  The^r^ 
virus  is  at  and  near  the  pointed  end  of  the  ivory  carrier.  Moisten  the  lymph 
upon  the  ivory  point  with  half  a  drop  of  pure  cool  water  smeared  over  it  with 
the  lancet.  Then  rub  tlie  point  over  the  scarified  surface  hrisJcly  for  a  minute 
so  as  to  lodge  the  granules  in  the  abraded  surface.  The  lymph  which  may  be 
deposited  on  the  sound  skin  should  be  scraped  upon  the  scarified  place  and 
allowed   to  dry  there.      When  the  arm  is  dry  return  its  ordinary  clothing. 


FIRST  EFFECTS  OF   VACCINATION.  0 

between  which  and  the  arm  a  loose,  soft  cloth  may  bo  fastened.  Do  not  put 
on  a  tight  bandage  or  any  plaster.  Let  no  saliva  touch  the  scratched  place, 
neither  to  atlix  a  plaster  nor  in  any  way.  "When  an  ivory  point  has  been  used 
throw  it  in  the  fire.  Except  there  is  urgent  necessity,  do  not  use  the  same 
point  on  two  persons,  and  not  then  if  there  is  dariger  of  communicating  dis- 
ease. Vaccination  sometimes  fails  because  the  arm  is  not  well  scarified  and 
the  virus  is  not  thoroughly  rubbed  into  the  scarified  surface.  A  skillful  vac- 
cinator can  generally  use  sufficient  care  to  insure  success  in  a  susceptible 
person.  Never  cut  entirely  through  the  skin.  Virus  should  not  be  inserted 
under  the  skin.  Except  with  young  children,  and  with,  feeble  persons,  for 
whom  only  one  place  is  recommended,  two  or  more  places  an  inch  or  more 
apart  may  be  scarified  and  vaccinated. 

11.  After  vaccination. — Let  the  vaccinated  place  alone.  Do  not  scratch  it 
or  otherwise  transfer  the  virus  where  it  is  not  wanted. 

12.  Common  appearances  after  vaccination. — For  a  day  or  two  nothing  unusual 
should  appear.  A  few  days  after  that,  if  it  succeeds  regularly,  the  skin  will 
become  red,  then  a  pimple  will  form,  and  on  the  pimple  a  little  vesicle  or  blis- 
ter which  may  be  plainly  seen  on  the  fifth  or  sixth  day.  On  the  eighth  day 
the  blister  (vesicle)  is,  or  should  be,  plump,  round,  translucent,  pearly  white, 
with  a  clearly  marked  edge,  and  a  depression  in  the  center;  the  skin  around  it 
for  about  half  an  inch  is  red  and  swollen.  This  vesicle  and  the  red  inflamed 
circle  about  it  (called  the  areola)  are  the  two  points  which  prove  the  vaccina- 
tion to  be  successful.  A  rash,  and  even  a  vesicular  eruption,  sometimes 
comes  on  the  child's  body  about  the  eighth  day,  and  lasts  about  a  week;  he 
may  be  feverish,  or  may  remain  quite  well.  The  arm  may  be  red  and  swollen 
down  as  far  as  the  elbow,  and  in  an  adult  there  will  usually  be  a  tender  or 
swollen  gland  in  the  armpit,  and  some  disturbance  of  sleep  for  several  nights. 
The  vesicle  dries  up  in  a  few  days  more,  and  a  crust  forms  which  becomes  of  a 
brownish  mahogany  color,  and  falls  ofE  from  the  twentieth  to  the  twenty-fifth 
day.  In  some  cases  the  several  appearances  described  above  may  be  delayed 
a  day  or  two.     The  crust  or  scab  will  leave  a  well-marked,  permanent  scar. 

13.  Signs  of  successful  revaccination, — When  a  person  who  has  been  once  suc- 
cessfully vaccinated  is  afterwards  revaccinated  there  sometimes  results  a  vesicle 
which,  as  regards  its  course  and  that  of  the  attendant  areola,  cannot  be  dis- 
tinguished from  the  perfect  results  of  a  primary  vaccination,  and  this  is  more 
likely  to  occur  if  bovine  virus  is  used.  But  often  the  result  is  modified  by  the 
influence  of  the  previous  vaccination,  no  true  vesicle  forms,  but  merely  a  pap- 
ular elevation  surrounded  by  an  areola;  and  this  result  having  attained  its 
maximum  on  or  before  the  fifth  day,  afterwards  quickly  declines.  Or,  if  a 
vesicle  forms,  its  shape  is  apt  to  vary  from  that  of  the  regular  vesicle,  and  its 
course  to  be  more  rapid,  so  that  its  maturity  is  reached  on  or  before  the  sixth 
day,  its  areola  declines  on  or  before  the  eighth  day,  and  the  scabbing  begins 
correspondingly  early.  In  either  case  the  areola  tends  to  diffuse  itself  more 
widely  and  less  regularly,  and  with  more  affection  of  the  areolar  tissue  than  in 
primary  vaccination,  while  the  itching  and  feverishness  may  be  present  much 
the  same  as  in  primary  vaccination.  When  the  results  of  a  revaccination  are 
not  well-marked,  protection  should  not  be  presumed  unless  the  same  virus  is 
proved  to  be  efficient  in  a  primary  vaccination. 

14.  What  to  do  during  and  after  vaccination. — Do  nothing  to  irritate  the 
eruption,  do  not  pull  the  scab  off,  when  it  drops  off  throw  it  in  the  fire. 
When  the  eruption  is  at  its  height  show  it  to  the  doctor  who  performed  the 


6  PREVENTION  OF  SMALL -POX. 

vaccination.  If  it  is  satisfactory,  ask  him  for  a  certificate  stating  when  and  by 
whom  yon  were  vaccinated,  whether  with  bovine  or  humanized  lymph,  in  how 
many  places  and  with  what  result  at  each  place.  When  the  arm  is  healed,  if 
the  vaccination  did  not  work  well,  he  vaccinated  again  and  as  soon  as  possible,  and 
in  the  best  manner  possible.  This  will  be  a  test  of  the  protection  secured  by 
the  former  vaccination,  and  will  itself  afford  increased  protection.  Do  not  be 
satisfied  with  less  than  four  genuine  vaccine  scars,  or  with  four  if  it  is  possible 
to  secure  more  than  four.  This  vaccination  a  second  or  third  time  in  close 
succession  is  believed  to  be  hardly  less  important  than  vaccination  the  first 
time,  and  hardly  less  valuable  as  a  protection  against  small-pox.  Without 
doubt  many  persons  are  living  in  a  false  sense  of  security  from  small-pox 
because  at  sometime  in  their  lives  they  have  had  a  little  sore  on  their  arms 
caused  by  a  supposed  or  a  real  vaccination,  or  because  an  imperfect  vaccination 
failed  to  "work,"  or  because  they  were  successfully  vaccinated,  or  had  the  vario- 
loid, or  the  unmodified  small-pox  many  years  ago.  Until  small-pox  is  stamped 
out  throughout  the  world  so  that  exposure  to  the  disease  shall  be  practically 
impossible,  the  only  personal  safety  is  in  such  perfect  and  frequent  vaccination 
that  one  need  not  fear  an  exposure  to  small-pox  through  the  recklessness  of  the 
foolish.  Statistics  abundantly  prove  that  among  the  unvaccinated,  small-pox 
has  lost  none  of  the  deadly  power  which  made  it  such  a  terror  to  former 
generations. 

15.  Make  a  record  of  your  vaccination. — Do  not  fail  to  procure  and  preserve 
the  certificate  mentioned  in  the  preceding  paragraph,  and  also  to  make  a  per- 
sonal record  of  the  facts  with  regard  to  any  vaccination  of  yourself  or  in  your 
family.  From  it  you  may  sometime  learn  that  it  is  ten  years  since  you  or 
some  member  of  your  family  was  vaccinated,  when  you  thought  it  only  five. 

16.  Vaccination  before  admission  to  the  schools. — In  some  places,  and  with 
good  results,  the  board  of  education  has  made  the  possession  of  a  certificate 
signed  by  some  competent  physician,  stating  that  the  child  has  been  success- 
fully vaccinated  within  a  given  number  of  years  or  months,  a  condition  to 
admission  to  the  public  schools.  Such  a  regulation  seems  to  be  one  of  the 
most  eJBficient  means  of  securing  a  general  vaccination  of  the  young  people. 

17.  Corporations  and  large  business  firms  may  well  prevent  interruption  of 
their  business  by  small-pox  by  requiring  employees  to  exhibit  certificates  of 
successful  vaccination,  and  of  revaccination. 

18.  Do  not  Delay  to  be  vaccinated. — By  setting  about  it  at  once  there  will  be 
time  to  secure  pure  and  fresh  vaccine  virus,  and  neither  sickness  nor  haste 
need  prevent  a  successful  vaccination.  But  if  one  puts  it  off,  he  may  sud- 
denly be  called  away  on  an  unexpected  journey  in  which  he  may  incur 
greater  risk  of  exposure  to  small-pox,  or  small-pox  may  appear  in  his 
vicinity  and  for  want  of  time  to  procure  reliable  vaccine  virus  he  may  be 
compelled  to  accept  vaccination  with  virus  neither  fresh  and  active  nor  of 
known  purity ;  and  vaccination  with  inferior  virus,  while  it  affords  but  little 
protection  aginst  small-pox,  may  be  a  hindrance  to  successful  vaccination  with 
the  best  virus;  or  by  his  delay  he  may  contract  small-pox  itself,  with  all 
its  dangers  and  with  an  expense  many  times  larger  than  the  cost  of  thorough 
vaccination. 

19.  Small-pox  occurs  at  all  seasons  of  the  year,  but  as  a  rule  is  most  preva- 
lent in  cold  weather.  It  lias  been  suggested  that  this  may  bo  in  part  due  to  a 
lack  of  ventilation  in  winter,  by  which  the  poison  becomes  more  concentrated, 
and  to  the  greater  irritation  and  rawness  of  the  throat  and  air-passages  caused 


RESTRICTION  OF  SMALL -POX.  V 

by  the  cold,  dry  air  and  by  tlio  more  abundant  ozone  in  winter,  the  sore  throat 
supplyi.ig  a  phice  wliere  small-pox  may  easily  bo  inoculated  ;  it  is  known  also 
that  in  a  warm,  moist  air  vaccino  virus  decomposes  more  readily  than  in  a  cold, 
dry  air,  and  tiie  same  is  probably  true  of  small-pox  virus.  This  greater  lia- 
bility to  small-pox  in  winter  makes  it  important  that  one  should  not  wait  till 
•winter  and  its  dangers  have  come  before  being  vaccinated,  and  also  that  he 
should  not  suffer  the  winter  to  pass  without  being  vaccinated. 

20.  Small-pox  not  spontaneoiislv  generated. — It  is  believed  that  neither  small- 
pox nor  any  other  strictly  contagious  disease  is  originated  in  Michigan,  and 
that  small-pox  may  in  great  part  bo  kept  out  of  the  State  if  proper  measures 
are  taken,  such  as  the  systematic  inspection  of  immigrants  and  travelers  and 
the  isolation  and  disinfection  of  all  infected  material. 

21.  Premises. — Privies,  cesspools,  watei'closets,  drains,  gutters,  and  all  other 
such  places  liable  to  receive  the  contagium  of  a  disease  should  be  frequently 
and  liberally  treated  with  the  copperas  solution  mentioned  in  paragraph  9, 
page  9. 

22.  Rags. — No  person  should  handle  old  clothing  or  rags  without  taking  pre- 
cautions to  prevent  the  spread  of  communicable  diseases.  Children  should 
not  be  allowed  to  go  near  a  rag-gatherer's  collection,  nor  into  the  rag-rooms 
in  paper-mills  or  store-houses. 

KESTEICTION  OF  SMALL-POX. 

When  small-pox  appears  in  a  place  it  is  generally  possible  to  restrict  it  to 
the  first  case  or  set  of  cases.  Five  things  should  immediately  be  done,  and 
several  other  things  should  without  fail  be  done  in  their  proper  order,  some- 
■what  as  follows : — 

1.  Notice  to  the  local  board  of  health. — The  house-holder  within  whose  family 
a  case  of  small-pox  occurs,  and  the  physician  called  to  treat  a  case  of  small- 
pox should  at  once  give  notice  thereof  to  the  health  officer  (or  to  the  local 
board  of  health),  as  required  in  townships  by  sections  1734  and  1735  of  the 
compiled  laws  of  1871,  and  in  cities  and  villages  by  section  1740  of  the  com- 
piled laws  of  1871,  as  amended  in  1879.  Sections  1734  and  1735  (sections  43 
and  44  of  chapter  46),  compiled  laws  of  Michigan,  1871,  are  as  follows: — 

(1734.)  Sec.  43.  Whenever  any  householder  shall  know  that  any  person  within  his  Houseliolders  to 
family  is  taken  sick  with  the  small-pox,  or  any  other  disease  dangerous  to  the  public  Ej'*'®  not'ce  of 
}iealt}i,ho  shall  immediately  give  notice  thereof  to  the  Board  of  Health,  or  to  the  for  neglect."     ^ 
Health   Officer  of  the  township  [city,  or  village*!  in  which  he  resides;  and  if  he 
shall  refuse  or  neglect  to  give  such  notice,  he  shall  forfeit  a  sum  not  exceeding  one 
hundred  dollars. 

(1735.)  Sec.  44.  Whenever  any  physician  shall  know  that  any  person  whom  he  is  pej,a](y  qq  ^jjy 
called  to  visit  is  infected  with  the  small-pox,  or  any  other  disease  dangerous  to  the  eician  neglectiu" 
public  healthy  such  physician  shall  immediately  give  notice  thereof  to  the  Board  of  to  glvo  notice. 
Health,  or  Health  Officer  of  the  township  [city,  or  village*]  in  which  such  diseased 
person  may  be;  and  every  physician  who  shall  refuse  or  neglect  to  give  such  notice, 
shall  forfeit,  for  each  offense,  a  sum  not  less  than  fifty  nor  more  than  one  hundred 
dollars. 

Section  1740,  as  amended  by  Act  No.  145,  laws  of  1879,  is  as  follows: — 

(1740.)  SEC.  49.  The  mayor  and  aldermen  of  each  incorporated  city,  and  the  presi-  Board  of  Health 
dent  and  council,  or  trustees  of  each  incorporated  village  in  this  State,  in  which  no  j"  cities  and  vil- 
board  of  health  is  organized  under  its  charter,  shall  have  and  exercise  all  the  pow-  constitute. 
ers  and  perform  all  the  duties  of  a  board  of  health  as  provided  in  this  chapter, 
within  the  limits  ef  the  cities  or  villages,  respectively,  of  which  they  are  such 
officers.    The  provisions  of  this  chapter,  and  the  amendments  thereto,  shall,  as  far 

*See  section  (1740)  Sec.  49,  as  amended  by  Act  No.  145,  Laws  of  1879,  on  this  and  following  page. 


o  RESTRICTION  OF  SMALL -POX. 

as  applicable,  apply  to  all  cities  and  villages  in  this  State,  and  all  duties  which  are, 
Dnties  of  officers  ^^  ^^^  provisions  of  this  chapter,  to  be  performed  by  the  board  of  health  of  town- 
and  inhabitants  ships.  or  by  the  officers  and  inhabitants  thereof,  shall  in  like  manner  be  performed 
of  cities  and  by  the  board  of  health  and  the  officers  and  inhabitants  of  such  cities  and  villages, 
villages.  with  a  like  penalty  for  the  non-performance  of  such  duties,  excepting  in  cases 

where  the  charters  of  such  cities  and    villages  contain   provisions  inconsistent 

herewith. 

2.  Vaccination  of  attendants  and  all  exposed. — The  attendants  on  the  sick 
with  sinall-pox  and  all  other  persons  who  it  is  feared  have  been  exposed  to 
small-pox  or  varioloid,  should  immediately  be  vaccinated.  If  properly  vacin- 
ated.  within  a  day  or  two  after  exposure  to  small-pox,  a  person  has  a  good 
chance  to  escape  small-pox  entirely,  and  if  he  should  come  down  with  vario- 
loid or  modified  small-pox  he  will  probably  have  the  disease  in  a  much  milder 
form  than  if  not  recently  vaccinated.  (See  page  3,  paragraph  5, — Preven- 
tion of  Small-pox.)     Unless  the  eruption  has  already  appeared,  vaccinate. 

3.  Restriction  of  the  Infection. — As  the  contagium  of  small-pox  harbors  in 
carpets,  bedding,  clothing,  etc.,  it  is  best  to  prepare  the  room  in  which  one 
sick  with  small-pox  is  to  be  cared  for,  removing  the  carpets,  pictures,  sofas, 
etc.,  the  bedding  and  clothing  not  required  for  actual  use  in  the  room,  and 
any  other  articles  capable  of  harboring  the  infection  and  which  it  would  be 
difficult  to  disinfect  or  not  desirable  to  burn.  Such  removals  of  carpets,  bed- 
ding, etc.,  should  not  be  attempted  after  they  have  been  exposed  to  infection, 
unless  properly  disinfected  under  the  direction  of  the  health  officer.  (See 
paragraphs  12  and  15,  page  10,  of  this  document.) 

4.  Isolation — Those  sick  with  small-pox  or  suspected  small-pox  should  at 
once  be  separated  from  all  other  persons  except  the  necessary  attendants  on  the 
sick. 

5.  Care  of  those  exposed  to  small-pox — All  persons  known  to  have  been 
exposed  to  small-pox  should  at  once  be  vaccinated,  and  should  be,  so  far  as 
possible,  isolated  from  others  until  it  is  known  whether  they  have  contracted 
small-pox.     This  "period  of  incubation"  is  usually  about  twelve  or  fifteen  days. 

6.  Notice  of  infected  place.— Placard  on  house — A  signboard  or  large  card  as 
a  signal  of  danger,  with  the  words,  small-pox  printed  on  it  in  large  plain 
letters  should  at  once  be  displayed  before  a  house,  and  a  large  card  with  the 
words  SMALL-POX  in  large,  plain  letters  should  be  fastened  on  the  door  of  a 
house,  in  which  is  a  case  of  small-pox ;  and  without  permission  of  the  health 
officer  no  person  should  be  allowed  to  come  to  the  house  or  go  from  it. 

7.  Who  may  attend  small-pox  patients. — Any  person  who  has  recently  been 
successfully  vaccinated  or  revaccinated,  or  has  recently  had  small-pox  or  vario- 
loid, may  attend  on  small-pox  patients  with  comparative  safety  to  himself,  and 
in  most  cases  with  absolute  safety  so  far  as  relates  to  danger  from  small-pox. 
No  person  who  has  been  vaccinated  or  has  had  varioloid  or  small-])ox  more 
than  ten  years  previously  should  rely  uj)on  such  experience  for  security  from 
small-pox,  if  exposed  by  attendance  on  a  person  sick  with  small-pox  or  vario- 
loid.    Such  a  person  should  immediately  be  revaccinated. 

''It  is  now  fully  established  that  a  typical  vaccine  scar  is  not  proof  of  the 
immunity  of  the  individual  from  small-pox.  We  have  admitted  to  the  hos- 
pital *  *  *  711  cases  of  small-pox  exhibiting  typical  cicatrices;  of  which 
number  73  proved  fatal."— ^V.  M.  Welch,  M.  D.,  in  Philadelphia  Health 
Eeport,  1872. 

There  is  good  statistical  support  for  the  common  theory  that  the  protective 
influence  of  vaccination,   varioloid,   and  small-pox  dies  out  in  seven  years. 


DISINFECTION.  9 

This  is  novr  known  to  bo  absolutely  true  for  many  persons,  Init  there  is  no  one 
period  applicable  to  all  persons,  the  fact  being  that  while  vaccination  affords 
at  first  almost  absolute  protection,  its  inQucnce  is  gradually  worn  out.  Its  pro- 
tective influence  is  lost  much  sooner  in  some  persons  than  in  others,  but 
experience  has  shown  (as  in  Philadelphia  in  1871-2)  that  many  children  vac- 
cinated in  infancy  have  varioloid  before  they  are  seven  years  of  age,  while  in 
some  instances  one  vaccination  or  one  attack  of  small-pox  protects  the  indi- 
vidual through  life.  Inasmuch  as  many  persons  are  known  to  be  susceptible  to 
small-pox  or  vaccination  as  often  as  once  in  ten  years,  and  as  some  are  suscep- 
tible yet  more  frequently,  this  State  Board  of  Health  has  advised  revaccination 
every  five  years,  as  the  most  judicious  measure  for  the  prevention  of  small-pox. 

DISINFECTION.* 

8.  Disposal  of  infected  material. — All  discharges  from  a  small-pox  patient 
should  be  received  into  vessels  containing  a  strong  solution  of  copperas  (sul- 
phate of  iron),  or  the  zinc-solution  mentioned  in  paragraph  10.  In  cities 
where  sewers  are  in  use  *the  disinfected  discharges  may  be  thrown  into  the 
water-closet;  in  other  places  they  should  at  once  be  buried  at  least  100  feet 
distant  from  any  well ;  they  should  not  by  any  means  be  thrown  into  a  running 
stream  nor  into  a  cesspool.  All  cloths,  rags,  etc.,  used  about  the  patient  should 
at  once  be  burned,  or  where  that  is  impracticable  should  be  thrown  into  a 
strong  zinc-solution.  If  necessary,  discharges  from  the  patient  may  be  received 
on  old  cloths  which  should  at  once  be  burned  or  disinfected  and  buried.  All 
vessels  should  be  kept  clean  and  disinfected. 

Bedding,  clothing,  etc.,  should  so  soon  as  removed  from  the  patient  be 
burned.  If  it  is  too  valuable  to  be  destroyed,  it  should  at  once  be  disinfected 
by  boiling  in  the  zinc-solution,  by  heating  in  a  specially  prepared  disinfecting- 
chamber  to  a  temperature  of  250°  Fahr.,  or  by  long  exposure  in  a  close  room 
or  box  to  the  fumes  of  burning  sulphur,  as  stated  in  paragraph  12,  page  10. 

Cotton,  linen,  flannels,  blankets,  etc.,  should  he  treated  with  the  boiling  hot  zinc-solution,  intro- 
ducing them  piece  by  piece,  securing  thorough  wetting,  and  boiling  for  at  least  half  an  hour. 

Heavy  woolen  clothing,  silks,  furs,  stuffed  bed-covers,  beds,  and  other  articles  which  cannot  be 
treated  with  the  zinc-solution,  should  be  hung  in  the  room  during  fumigation,  pockets  being 
turned  inside  out  and  the  whole  garment  thoroughly  exposed.  Afterward  they  should  be  hung  in 
the  open  air,  beaten  and  shaken.  Pillows,  beds,  stuffed  mattresses,  upholstered  furniture,  etc., 
should  be  cut  open,  the  contents  spread  out  and  thoroughly  fumigated.  Carpets  are  best  fumi- 
gated on  the  floor,  but  should  afterward  be  removed  to  the  open  air  and  thoroughly  beaten,  after 
which  they  may  well  be  again  exposed  to  fumes  of  burning  sulphur. 

9.  The  copperas-solution  may  be  prepared  by  dissolving  sulphate  of  iron 
(copperas)  in  water  in  the  proportion  of  one  and  a  half  pounds  of  copperas  to 
a  gallon  of  water.  When  much  is  wanted  it  may  be  prepared  by  hanging  a 
basket  containing  about  sixty  pounds  of  copperas  in  a  barrel  of  water. 

10.  The  zinc-solution  may  be  prepared  by  dissolving  sulphate  of  zinc  and 
common  salt  in  water  in  the  proportion  of  four  ounces  of  zinc-sulphate  and 
two  ounces  of  salt  to  a  gallon  of  water. 

11.  Care  of  rooms,  etc.,  during  sickness. — So  far  as  consistent  with  the  welfare 
of  the  patient,  the  room  throughout  the  sickness  should  be  constantly  ven- 
tilated and  frequently  aired.  To  confine  the  poison  in  a  close  room  is  to  retain 
its  power  of  infecting  others.  It  is  well  to  provide  for  disinfecting  the  foul 
air  withdrawn  from  the  room,  as  by  an  open  fire-place  where  this  is  practicable, 

*  These  methods  of  disinfection  are  applicable  in  other  contagious  diseases,  such  as  scarlet  fever, 
diphtheria,  etc.  For  the  statement  of  some  of  the  methods  herein  described  the  State  Board  of 
Health  is  indebted  to  a  circular  on  disinfection  (No.  S)  issued  by  the  National  Board  of  Health. 


10  KESTEICTION   OF   SMALL -POX. 

or  by  fines  leading  into  furnaces,  or  kept  constantly  fumigated  in  some  manner. 
It  is  well  to  keep  in  the  sick-room  a  vessel  containing  the  zinc-solution  (men- 
tioned in  a  preceding  paragraph)  for  the  reception  of  towels,  sheets,  and 
other  articles  of  clothing  which  are  not  to  be  burned  or  disinfected  in  a 
specially  prepared  oven. 

12.  Disinfection  after  death,  recovery,  or  removal. — After  death,  recovery,  or 
removal  there  should  take  place,  under  the  supervision  of  the  healtii  officer, 
the  most  thorough  and  complete  disinfection  of  the  house  and  the  contents  of 
the  house  in  which  there  has  been  a  case  of  small-pox.  It  is  far  better  for 
the  community  and  cheaper  for  the  board  of  health  to  pay  a  competent  man 
to  see  that  this  is  properly  done  than  to  take  the  risk  of  its  not  being  done 
well.  This  disinfection  should  be  done  with  fumes  of  burning  sulphur.  For 
this  purpose  the  room  to  be  disinfected  must  be  vacated.  Heavy  clothing, 
blankets,  bedding,  and  other  articles  which  cannot  be  treated  with  zinc-solu- 
tion, should  be  opened  and  spread  out  so  as  to  be  freely  exposed  during  fumi- 
gation. Close  the  doors  and  all  large  openings  to  the  room  as  tight  as  possible, 
but  do  not  use  paste,  or  in  any  such  way  cover  surfaces  which  need  to  be  dis- 
infected, nor  prevent  free  entrance  of  the  fumes  to  all  cracks  into  which  the 
contagium  may  have  entered.  Place  the  sulphur  in  iron  pans  supported  upon 
bricks,  set  it  on  fire  by  hot  coals  or  with  the  aid  _of  a  spoonful  of  alcohol  and 
a  lighted  match,  and  allow  the  rooms  to  remain  closed  for  several  hours.  For 
a  room  about  ten  feet  square,  two  pounds  of  sulphur  should  be  burned ;  for 
a  larger  room  a  proportionally  larger  quantity  should  be  used,  that  is  at  the 
rate  of  one  and  a  half  to  two  pounds  of  sulphur  to  each  one  thousand  cubic 
feet  of  air-space. 

13.  Carefully  avoid  breathing  the  fumes  of  the  burning  sulphur. — After  fumi- 
gation for  several  hours,  the  room  should  be  thoroughly  opened  and  aired, 
before  it  is  again  occupied. 

14.  Care  of  the  corpse. — The  corpse  should  be  wrapped  in  a  sheet  wet  with  a 
zinc-solution  of  double  the  strength  specified  in  paragraph  10,  page  9,  and 
bnried  at  once.  Metallic,  metal-lined,  or  air-tight  cofiins  should  be  used  when 
possible,  certainly  when  tlie  body  is  to  be  transported  for  any  considerable 
distance.  In  no  case  should  the  body  be  exposed  to  view  except  in  a  perfectly 
air-tight  coffin,  and  through  glass;  the  coffin  after  its  final  closure  having 
been  exposed  to  fumes  of  burning  sulphur. 

15.  Disinfection  of  rooms,  clothing,  etc.,  incidentally  exposed  to  infection. — Hotel- 
rooms,  stores,*  cars,  boats,  hacks  or  other  enclosures  which  may  have  been 
exposed  to  infection  should  be  carefully  disinfected  by  fumes  of  burning  sul- 
phur, as  specified  in  paragraph  12. 

IG.  Punerals — No  public  funeral  should  be  held  at  the  house,  and  no  one 
should  go  to  a  public  funeral  from  the  house  where  one  has  died  from  small- 
pox, or  the  inmates  have  been  exposed  to  the  disease.  Should  any  one  from 
an  infected  or  exposed  house  ride  to  a  funeral  or  a  grave  in  a  public  hack  the 
robes,  cushions,  etc.,  and  the  interior  of  the  hack  should  immediately  after- 
wards be  thoroughly  disinfected  by  exposure  for  several  hours  to  the  fumes  of 
burning  sulphur,  as  described  in  paragraph  12. 


UUSriTALS.  11 

17.  Care  of  convalescents. — After  recovery  the  patient  sliould  not  be  allowed 
to  go  abroad  or  to  receive  visitors  until  his  clothing,  etc.,  has  been  carefully 
disinfected  under  the  supervision  of  tiie  health  officer,  and  until  he  has 
received  from  tiie  health  officer  or  from  eomo  competent  physician  a  properly 
authenticated  statement  which  is  approved  by  the  health  officer  that  there  is 
no  longer  any  dutiger  of  his  communicating  tlie  disease. 

18.  Hospitals  for  persons  sick  with  diseases  dangerous  to  the  public  health. — 
As  a  means  of  preventing  the  spread  of  disease,  tlio  law  authorizes  tlie  inhab- 
itants of  townships,  cities,  and  villages  to  be  constantly  provided  with  hospitals 
for  the  reception  of  persons  having  small-pox,  or  any  other  disease  dangerous 
to  the  public  hcaltii ;  and  directs  local  boards  of  health  on  the  outbreak  of 
any  such  disease  to  provide  such  hospitals  or  places  of  reception  for  the  sick 
and  infected  as  they  shall  judge  best  for  their  accommodation  and  the  safety  of 
the  inhabitants,  and  to  cause  such  sick  or  infected  persons,  if  their  condition 
-will  admit,  to  be  removed  to  such  hospitals  or  places  of  reception, — said  hos- 
pitals, and  (in  case  the  sick  cannot  be  removed  to  the  hospital  without  danger 
to  life  or  health)  the  houses  where  the  sick  may  remain,  and  all  persons  con- 
nected with  said  hospitals  or  abodes  of  the  sick  to  be  subject  to  the  regulations 
of  the  board  of  healtii,  or  of  a  committee  appointed  by  the  board  of  health 
for  that  purpose.  Sections  172G-1733  of  the  Compiled  Laws  of  1871,  relating 
to  this  subject,  and  by  amended  section  1740  (being  Sees.  35-42,  and  49  of 
chapter  XLVI.)  made  equally  applicable  to  cities,  villages,  and  townships,  are 
as  follows : 

(17-26.)  Sec.  35.  The  inhabitants  of  any  township  may  establish  -within  their  town-  Hospitals  for 
ship  and  be  constantly  provided  -with  one  or  more  hospitals  for  the  reception  of  goJ^,g^{i'°"iQg  P"* 
pei'sons  having  the  small-pox,  or  other  disease  -which  may  bo  dangerous  to  the  sQiall-pox,  etc. 
public  health. 

(1727.)  Sec.  3C.  All  such  hospitals  shall  be  subject  to  the  orders  and  regulations  of  By  whom  hospi- 
the  board  of  health,  or  a  conamittee  appointed  by  such  board  for  that  purpose;  but  [^{^^g^®  '"®^"" 
no  such  hospital  shall  be  established  within  one  hundred  rods  of  any  inhabited  ' 

dvrelling-house  situated  in  an  adjoining  township,  without  the  consent  of  such 
adjoining  township. 

(1728.)  Sec.  37.  If  any  person  shall  inoculate  any  other  person,  or  inoculate  him-  Penalty  for  in- 
self,  or  suffer  himself  to  be  inoculated,  with  the  small-pox,  unless  at  some  hospi-  "^'J^^''""  ^'^'^ 
tal  licensed  and  authorized  by  law,  he  shall,  for  each  offense,  forfeit  a  sum  not  cept  at  hospitals, 
exceeding  two  hundred  dollars. 

(17-29.)  Sec.  38.  When  any  hospital  shall  be  so  established,  the  physician  attend-  Physicians,  etc., 

ing  the  same,  the  persons  inoculated  or  sick  therein,  the  nnrses,  attendants,  and  <°  "^f  subject  to 

.,„,  ,,,t  regulations  of 

all  persons  who  shall  approach  or  come  within  the  limits  of  the  same,  and  all  such  ijo^rd,  etc, 

furniture  and  other  articles  as  shall  be  used  or  brought  there  shall  be  subject  to 

such  regulations  as  shall  be  made  by  the  board  of  health,  or  of  the  committee 

appointed  for  that  purpose. 

(1730.)  Sec.  3').  When  the  small-pox  or  any  other  disease  dangerous  to  the  public  when  board  of 
health  shall  break  out  in  any  township,  the  board  of  health  shall  immediately  pro-  healih  to  provide 
vide  such  hospital,  or  place  of  reception  for  the  sick  and  infected,  as  they  shall     °^P' '' 
judge  best  for  their  accommodation  and  the  safety  of  the  inhabitants;  anil  such 
hospitals  and  places  of  reception  shall  be  subject  to  the  regulations  of  the  board  of 
health,  in  the  same  manner  as  hereinbefore  provided  for  established  hospitals. 

(1733.)  Sec.  42.  If  any  physician  or  other  person  in  any  of  the  hospitals  or  places  Penalty  for  vio- 
of  reception  before  mentioned,  or  who  shall  attend,  approach,  or  be  concerned  luting  regula- 
with  the  same,  shall  violate  any  of  the  regulations  lawfully  made  in  relation  there-  t^"".^  ° 
to,  either  with  respect  to  himself,  or  his  or  any  other  person's  property,  the  person 
so  offending  shall,  for  each  offense,  forfeit  a  sum  not  less  than  ten  nor  more  than 
one  hundred  dollars. 

19.  Hospital  construction,  ventilation,  warming,  etc. — In  the  construction  and 
management  of  hospitals  great  care  should  be  had  for  the  comfort,  safety,  and 
health  of  those  confined  in  or  connected  with  them,  as  well  as  for  the  safety  of 
the  public. 


12  RESTRICTION  OP   SMALL -POX. 

The  proper  size  and  plan  for  such  a  hospital  may  vary  somewhat  for  differ- 
ent localities ;  but  a  few  general  principles  which  should  be  considered  may  be 
mentioned  here.  Particular  attention  should  be  paid  to  ventilation.  The  foul 
air  should  be  drawn  off  through  an  opening  or  openings  in  the  floor  or  in  the 
wall  at  the  floor-level,  into  a  heated  flue  open  at  the  top.  In  cold  weather  the 
fresh  air  should  be  warmed  before  it  enters,  or  as  it  enters  the  room.  This 
may  be  done  by  a  furnace  or  by  steam  coils  in  fresh  air  ducts.  If  stoves  are 
used,  this  can  be  done  by  jacketing  the  stove  and  providing  an  inlet  pipe  for 
fresh  air  from  out  door  to  the  back  of  the  stove  within  the  sheet-iron  jacket, 
as  described  on  pages  55-63  of  the  Eeport  of  the  State  Board  of  Health  for 
1879,  and  on  pages  263-6  of  the  Report  for  1880. 

20.  Removal  of  sick  or  infected  persons. — The  law  provides  that  the  board  of 
health  ''shall  make  effectual  provision  in  the  manner  in  which  they  shall  judge 
best  for  the  safety  of  the  inhabitants,"  sections  1706,  1731,  and  1707,  com- 
piled laws  of  1871,  being  as  follows : — 

Board  to  make       (1706.)  SEC.  15.  'When  any  person  coming  from  abroad  or  residing  in  any  township 
provision  to  pre-  -within  this  State,  shall  be  infected,  or  shall  lately  before  have  been  infected,  with 
emall-pox   etc.     *^^  small-pox,  or  other  sickness  dangerous  to  the  public  health,  the  board  of  health 
of  the  township  where  such  person  may  be  shall  make  eflfectual  provision  in  the 
manner  in  which  they  shall  judge  best  for  the  safety  of  the  inhabitants,  by  remov- 
ing such  sick  or  infected  person  to  a  separate  house,  if  it  can  be  done  without  dan- 
ger to  his  health,  and  by  providing  nurses  and  other  assistance  and  necessaries, 
which  shall  be  at  the  charge  of  the  person  himself,  his  parents,  or  other  person  who 
3 Mich.  Eep. 475.  may  be  liable  for  his  support,  if  able;  otherwise,  at  the  charge  of  the  county  to 

which  he  belongs. 
When  infected        (1731.)  SEC.  40,  The  board  of  health  shall  cause  such  sick  or  infected  persons  to  be 
persons  to  be  re-  removed  to  such  hospitals  or  places  of  reception,  unless  the  condition  of  the  sick 
tal^'^efc*^  ^°*^''  person  be  such  as  not  to  admit  of  removal  without  danger  to  life;  in  which  case  the 
house  or  place  where  the  sick  shall  remain  shall  be  considered  as  a  hospital  to  every 
purpose  before  mentioned,  and  all  persons  residingin  or  in  any  way  concerned  with 
the  same,  shall  be  subject  to  the  regulations  of  the  board  of  health,  as  before  pro- 
vided. 
Provision  Incase     (1707.)  SEC.  16.  If  any  such  infected  person  cannot  be  removed  without  danger  to 
infected  persons   his  health,  the  board  of  health  shall  make  provision  for  him  as  directed  in  the  pre- 
cannot  be  re-      ceding  section,  in  the  house  in  which  he  may  be,  and  in  such  case  they  may  cause 
the  persons  in  the  neighborhood  to  be  removed,  and  may  take  such  other  measures 
as  they  may  deem  necessary  for  the  safety  of  the  inhabitants. 

21.  Nurses  and  necessary  supplies. — Persons  thus  restrained  at  hospital  or  at 
home  should  be  permitted  to  provide  themselves,  or  the  local  board  of  health 
should  provide  them,  with  the  best  nursing  and  medical  care.  The  duty  of  the 
board  of  health  is  not  primarily  to  assume  the  care  and  medical  treatment  of 
the  person  sick  with  small-pox  or  other  disease  dangerous  to  the  public  health, 
but  to  place  that  care  and  treatment  under  such  regulations  as  will  protect  the 
community  from  the  spread  of  the  disease;  but  persons  thus  restrained  for 
the  public  good  are  generally  prevented  from  earning  their  own  support,  and 
the  public  in  thus  enforcing  unusual  conditions  is  bound  to  provide  proper  care 
and  medical  treatment,  food,  etc.,  for  those  not  able  to  provide  for  themselves. 
The  board  of  health  is  authorized  and  required  to  "provide  nurses  and  other 
assistance  and  necessaries,"  at  the  charge  of  the  person  sick,  or  of  those  liable 
for  his  support,  if  able  (in  which  case  the  sick  person  will  choose  his  own  med- 
ical attendants),  otherwise  at  the  charge  of  the  county  to  which  he  belongs. 
This  is  provided  for  by  sections  1706  and  1707,  compiled  laws  of  1871,  printed 
above.  See  also  Third  Michigan  Report,  page  475,  in  which  the  supreme  court 
in  1855  granted  a  writ  of  mandamus  to  compel  the  board  of  supervisors  of 
Macomb  county  to  pay  a  claim  for  care  of  an  indigent  person  sick  with 
small-pox,  which  claim  had  been  audited  by,  and  was  for  services  ordered  by, 


DUTIES  UF  LOCAL  BOARDS  OF  HEALTH.  15 

the  board  of  health  of  the  vilhige  of  Mt.  Clemens,  under  section  170G,  being 
section  15  of  chapter  XLVI.  of  the  revised  statutes  of  184C. 

22.  Houses,  supplies,  nurses,  etc.,  paid  by  the  county  in  certain  cases. — Nurses  and 
attendants  employed  by  the  sherill  or  other  oihcer  in  accordance  with  section 
1709,  owners  of  houses,  stores,  lodgings,  or  other  necessaries  taken  possession 
of  by  either  of  said  ollicers  in  accordance  with  sections  1709-1712,  and  other 
persons  properly  employed  by  said  officers  to  assist  in  the  duties  enjoined  by 
said  sections,  are  entitled  to  just  compensation,  to  be  paid  by  the  county. 
This  is  provided  by  section  1714,  as  follows: 

(17U.)  Sec.  2a.  Whenever  the  sheriff  or  other  officer  shall  take  possession  of  any  ComponBation 
houses,  stores,  lodgings,  or  other  necessaries,  or  shall  employ  any  nurse  or  attend-  f"""  •'cii«ee, 
ants,  as  iirovidcd  in  this  chapter,  the  several  parties  interested  shall  be  entitled  to  a  ' 

just  compensation  therefor,  to  be  paid  by  the  county  in  which  such  person  or  prop- 
erty shall  have  been  so  employed  or  taken  possession  of. 

23.  Duties  of  the  local  board  of  health — In  view  of  known  means  of  preventing 
and  restricting  small-po-T,  it  would  seem  to  be  the  duty  of  the  local  board  of 
health : — 

(I.)  Frequently  to  offer  free  vaccination  at  any  time  to  all  persons  who  have 
not  been  successfully  vaccinated  within  the  preceding  five  years  ;  and  constantly 
to  place  before  the  people  the  importance  of  vaccination.  This  the  board  of 
health  is  authorized  to  do  by  Act  No.  146  of  the  laws  of  1879,  which  reads  as 
follows : — 

Section  1.  The  People  of  the  Stale  of  Michigan  enact.  That  the  board  of  health  in  Board  of  Health 

each  city,  village,  and  township  may,  at  any  time,  direct  its  health  officer  or  health  ai'^'ip^ized  to 

t-        .>  I  J  furnish  vaccina* 

physician  to  offer  vaccination  wilh  bovine  vaccine  virus  to  every  child  not  prevl-  jiou. 
ously  vaccinated,  and  to  all  other  persons  who  have  not  been  vaccinated  within  the 
preceding  five  years,  without  cost  to  the  persons  [person]  vaccinated,  but  at  the 
expense  of  such  city,  village,  or  township,  as  the  case  may  be. 

(II.)  To  enforce  the  law  (sections  1734  and  1735,  compiled  laws  of  1871, 
page  7  of  this  document),  requiring  householders  and  physicians  to  give  imme- 
diate notice  of  cases  of  small-pox  and  other  diseases  dangerous  to  the  public 
health.  What  it  is  the  duty  of  the  board  of  health  to  require  the  people  to  do 
for  their  own  safety  it  is  the  duty  of  the i^aopU  to  do  without  compulsion.  The 
board  of  health  should  have  as  prompt  notice  of  the  outbreak  of  a  contagious 
disease  as  the  fire  department  has  of  the  outbreak  of  fire,  and  as  hearty  coope- 
ration of  citizens  for  the  suppression  of  the  disease  as  is  given  the  fire  depart- 
ment for  the  suppression  of  fire.  And  when  the  board  is  informed  it  should 
act  as  promptly,  and  continue  to  act  as  faithfully,  as  is  done  for  the  extin- 
guishing of  a  fire. 

(III.)  To  secure  complete  isolation  of  those  sick  or  infected  with  small-pox. 

(IV.)  To  give  the  public  prompt  and  full  notice  of  infected  places  (section 
1733,  compiled  laws  1871,  printed  below.) 

(V.)  In  general,  and  in  compliance  with  the  following  section  of  law,  to  do 
all  that  may  be  done  by  prompt  and  intelligent  action  to  prevent  the  introduc- 
tion of  disease. 

(1732.)  Sec.  41.  When  the  small-pox,  or  any  other  disease  dangerous  to  the  public  Notice  of  fn- 
health,  is  found  to  exist  in  any  township  [city  or  village*]  the  board  of  health  shall  fected  places. 
use  all  possible  care  to  prevent  the  spreading  of  the  infection,  and  to  give  public  notice 
of  infected  places  to  travelers,  by  such  means  as  in  their  judgment  shall  be  most 
effectual  for  the  common  safety. 

(VI.)  To  secure  and  superintend  the  immediate  and  thorough  disinfection 
of  infected  houses,  material,  etc.,  as  directed  in  paragraphs  8-15,  pages  9-10 
of  this  document. 

*  See  Sec.  1740,  compiled  laws  of  1871,  as  amended  by  act  No.  145,  laws  of  1879,  printed  on  pages 
7-S  of  this  document. 


14  EESTEICTION  OP   SMALL -POX. 

(VII.)  Promptly  to  notify,  by  its  clerk  or  health  officer,  the  State  Board  of 
Health  upon  the  first  outbreak  of  small-pox,  or  any  other  disease  dangerous  to 
the  public  health,  in  accordance  with  published  requirements  of  the  State  Board 
of  Health  under  section  8  of  Act  No.  81,  laws  of  1873. 

24.  Board  of  health  should  instruct  its  health  officer. — In  order  that  no  time  may 
be  lost,  it  is  the  duty  of  every  board  of  health  to  make  provision  for  prompt 
action  by  its  health  officer,  authorizing  and  directing  him  to  be  prepared  at  all 
times,  as  executive  officer  of  the  board,  to  take  certain  action  without  waiting 
for  a  meeting  of  the  board,  whenever  a  case  of  small-pox  or  other  disease  dan- 
gerous to  the  public  health  occurs  within  its  jurisdiction.  Some  of  these 
duties  which  the  health  officer  should  be  directed  to  perform  may  be  briefly 
suggested  as  follows  : — 

He  should— 

a.  Promptly  verify  the  reports  of  cases  of  small-pox,  and  investigate  sus- 
pected cases  which  are  not  reported,  so  that  he  may  act  intelligently. 
i.  Secure  the  isolation  of  those  sick  with  or  exposed  to  small-pox. 

c.  See  that  no  person  suffers  for  lack  of  nurses,  etc.,  because  of  isolation  for 
the  public  good. 

d.  In  case  of  an  outbreak  of  small-pox,  secure  a  prompt  vaccination  of  all 
persons  who  have  been  or  may  be  exposed  to  the  disease. 

e.  Give  public  notice  of  infected  places.  (See  paragraph  6,  page  8,  also 
Sec.  1732,  compiled  laws  1871,  page  13.) 

/.  Eegulate  funerals  of  persons  dead  from  small-pox,  etc. 

g.  Disinfect  rooms,  clothing,  and  premises. 

h.  Give  certificates  of  recovery  and  of  freedom  from  liability  to  communicate 
the  disease. 

i.  Keep  his  own  board  of  health,  and  the  State  Board  of  Health,  constantly 
informed  respecting  every  outbreak  of  a  disease  dangerous  to  the  public 
health.     (See  paragraph  (vii.)  above.) 

25.  Notices  of  regulations  of  local  boards  of  health. — Though  a  more  general 
notice  than  is  required  by  law  should  always  be  given  of  regulations  made  by 
local  boards  of  health,  the  notice  required  by  section  1698,  compiled  laws  of 
1871,  should  never  be  omitted,  as  on  the  giving  of  this  notice  might  depend 
the  success  of  legal  proceedings  begun  by  the  jjoard  to  enforce  obedience  to 
its  regulations : 

Notice  of  regu-        (1698.)  SEC.  7.  Notice  shaU  toe  given  by  the  board  of  healtli  of  aU  regulations  made 

lations,  how  by  them,  by  publishing  the  same  in  some  newspaper  of  the  township,  if  there  be 

one  publisheil  therein,  and  if  not,  then  by  posting  them  up  in  five  public  places!  n 

such  township;  and  such  notice  of  said  regulations  shall  be  deemed  legal  notice  to 

all  persons. 

Section  1698  applies  also  to  boards  of  health  in  cities  and  villages;  and  in 
general  it  should  be  remembered  that  by  the  amended  section  1740  the 
provisions  of  all  sections  in  chapter  46  of  the  compiled  laws  of  1871,  including 
sections  1692-1744  and  the  amendments  thereto,  apply  so  as  far  applicable 
with  equal  obligation  to  the  inhabitants  and  the  boards  of  health  in  cities 
and  villages,  unless  chai'ter  provisions  conflict.  (See  Sec.  1740  in  paragraph 
1,  page  7-8  of  this  document.) 

26.  Inspection  of  travelers,  restraint  of  infected  persons. — Boards  of  health  of 
townships,  cities,  and  villages  near  to  or  bordering  upon  neighboring  States 
are  by  section  1708  (made  applicable  to  cities  and  villages  by  Act  145,  laws  of 
1879)  authorized  to  inspect  travelers,  and  to  restrain  from  travel  within  their 
jurisdiction,  except  by  license  from  the  board  of  health,  persons  coming  from 
infected  places  in  other  States.     Section  1708  is  as  follows : 


CARE  OF  INFECTED  PERSONS,  BAGGAGE,  CLOTHING,  ETC.         15 

(1708.)   Sec,  17.  Tho  board  of  lic.-jlth  of  any  township  near  lo  or  bordering  upon  Boardmayre- 
elther  of  the  ncighborinK  .Stiilcs,  may  aiipoint,  by  writing  under  tlicir  liands,  suita-  ■"■"'."  "'*^r[* ," 
Dle  persons  to  attend  any  places  by  wliicli  travelers  may  pass  from  infected  places  f,.cted  difitricts. 
in  other  States;  and  the  persons  so  ai)i)olnt(;d  may  examine  such  pasfiengcrs  as  they 
may  suspect  of  bringing  with  them  any  infection  wliich  may  be  dangei-oiis  to  the 
public  health,  and.  If  need  bo,  may  restrain  them   from  traveling  until  licensed 
thereto  by  tho   board  of  health  of  the  township  to  which  such  persons  may  come; 
and  any  person  coming  from  such  inftcted   i)lace,  who  shall,  without  license  aa 
aforesaid,  travel  within  this  State,  unless  it  bo  to  travel  by  the  most  direct  way  to 
tho  State  from  whence  he  came,  after  ho  shall  be  cautioned  to  depart  by  the  persons 
appointed  as  aforesaid,  shall  forfeit  a  sum  not  exceeding  one  hundred  dollars. 

27.  Permits  for  removal  of  an  infected  article  or  sick  person  may  be  granted 

by  the  board  of  liealth  in  its  discretion. 

(1705.)  Sec.  14.  The  board  of  health  may  grant  permits  for  the  removal  of  any  nui-  Board  may  per- 
sance.  Infected  article,  or  sick  iicrson  within  the  limits  of  their  township,  when  pi't  rcrnovalof 
..,.>.  ..I  -...,  .  ^    J  infected  articles, 

they  shall  think  it  safe  and  proper  so  to  do.  gj^ 

28.  Restraint  and  removal  of  infected  persons. — In  case  of  travelers  and  other 
persons  infected  with  any  disease  dangerous  to  the  public  health,  the  law  (sec- 
tion 1706  compiled  laws  of  1871,  in  paragraph  20,  page  12,  of  this  docu- 
ment) requires  the  local  board  of  health  to  make  effectual  provision  for  the 
safety  of  the  inhabitants, — including  removal  of  the  sick  person  to  another 
house  when  this  is  best  and  can  be  done  without  danger  to  the  health  of  the 
person  sick,  otlicrwiso  at  tlie  house  where  he  may  be. 

In  removing  and  caring  for  any  person  infected  with  contagious  sickness  the 
board  of  health  may  make  use  of  the  sheriff  or  any  constable  of  the  county, 
by  procuring  a  warrant  signed  by  any  two  justices  of  the  peace.  Section  1  709 
permits  this,  and  is  as  follows : 

(1709.)  Sec.  IS,  Any  two  justices  of  the  peace  may,  if  need  be,  may  make  out  a  war-  Removal  of  per- 
rant  under  their  hands,  directed   to  the  sheriff  or  any  constable  of  the  county,  sons  infected, 
requiring  him,  under  the  direction  of  the  board  of  health  to  remove  any  person 
infected  with  contagious  sickness,  or  to  take  possession  of  convenient  houses  and 
lodgings,  and  to  provide  nurses,  attendants,  and  other  necessaries  for  the  accom. 
modation,  safety,  and  relief  of  the  sick. 

29.  Control  of  infected  baggage,  clothing,  goods,  etc — Bysections  1710-1713  the 
board  of  health  is  authorized  to  procure  the  detention,  examination,  and  purifi- 
cation at  the  owner's  expense  of  any  baggage,  clothing,  or  goods  of  any  kind, 
found  within  the  township,  city,  or  village,  Avhich  there  is  just  cause  to  suspect 
to  be  infected  with  any  disease  dangerous  to  the  public  health.  These  sec- 
tions are  as  follows : 

(1710.)  Sec.  p.  Whenever  on  application  of  the  board  of  health,  it  shall  be  made  Infected  bag- 
to  appear  to  any  justice  of  the  peace  that  there  is  just  cause  to  suspect  that  any  gagf'i  clo'hing, 
baggage,  clothing,  or  goods  of  any  kind  found  within  the  township  are  infected  with  secured.    ' 
any  disease  which  may  be  dangerous  to  the  public  health,  such  justice  of  the  peace 
shall,  by  warrant  under  his  hand,  directed  to  the  sheriff  or  any  constable  of  the 
county,  require  him  to  tako  with  him  as  many  men  as  the  said  justice  shall  deem 
necessary    to    secure   such  baggage,  clothing,    or  other  goods,   anrl   to  post  said 
men  as  a  guanl  over  the  house  or  place  where  such  baggage,  clothing,  or  other 
goods  shall  be  lodged,  which  guard  shall  take  effectual  care  to  prevent  any  person 
removing  or  coming  near  to  such  baggage,  clothing  or  other  goods,  until  due  inquiry 
be  made  into  the  circumstances  thereof. 

(1711.)  Sec.  20.  The  said  justice  may  also,  by  the  same  warrant,  if  it  shall  appear  Impressing 
to  him  necessary,  require  the  said  ofliccr,  under  the  direction  of  the  board  of  health,  houses,  etc.,  for 
.    I  ,  •      ..  1  .  ^       .1  r     ■,  c         1.  keeping  infected 

to  impress  and  take  up  convenient  houses  or  stores  for  the  safe  keeping  of  such  goods. 

baggage,  clothing,  or  other  goods;  and  the  board  of  health  may  cause  them  to  be 
removed  to  such  houses  or  stores,  or  to  be  otherwise  detained,  until  they  shall,  in 
the  opinion  of  said  board  of  health,  be  freed  from  infection. 

(1712.)  Sec.  21.  Such  oflicer  in  the  execution  of  such  warrant,  shall,  if  need   be,  „  ,    _ 

,        ,  ,  ,  ^,  ,  ..•.■-,  ...         Power  of  officer 

break  open  any  house,  shop,  or  any  other  place  mentioned  in  said  Avarrant,  where  executing  -war- 
such  baggage,  clothing,  or  other  goods  shall  be;  and  he  may  require  such  aid  as  rant. 


16  RESTEICTION  OF  SMALL- POX. 

shall  be  necessary  to  effect  the  execution  of  the  warrant;  and  all  persons  shall,  at 

the  command  of  any  such  officer,  under  a  penalty  not  exceeding  ten  dollars,  assist 

in  the  execution  of  the  -warrant,  if  ahle  to  do  so. 
Charges  to  be  (1718.)  SEC.  22.  The  charges  of  securing  such  baggage,  clothing,  or  other  goods, 

paid  by  owner,     and  of  transporting  and  purifying  the  same,  shall  be  paid  by  the  owners  thereof,  at 

such  rates  and  prices  as  shall  be  determined  by  the  board  of  health. 

30.  Small-pox  in  a  jail — The  board  of  health  may  by  written  order  secure 
the  removal  from  a  common  jail  to  a  hospital  or  other  place  of  safety  of  a 
prisoner  attacked  with  a  disease  dangerous  to  the  safety  and  health  of  the 
other  prisoners  or  of  the  inhabitants  of  the  township,  city,  or  village.  Sections 
1715  and  1716  authorizing  and  prescribing  the  manner  of  such  removal  are  as 
follows : 

When  prlBoners       (1715.)  SEC.  24.  Whenever  any  person  confined  in  any  common  jail  shall  be  attacked 

attacked  with       -with  any  disease,  which,  in  the  opinion  of  the  physician  of  the  board  of  health,  or 

ease^may  be  re-     °^  such  other  physicians  as  they  may  consult,  shall  be  considered  dangerous  to  the 

moved.  safety  and  health  of  the  other  prisoners,  or  of  the  inhabitants  of  the  township,  the 

board  of  health  shall,  by  their  order  in  writing,  direct  the  removal  of  such  person 

to  some  hospital  or  other  place  of  safety,  there  to  be  provided  for  and  securely  kept, 

so  as  to  prevent  his  escape,  until  their  further  orders;  and  if  such  prisoner  shall 

recover  from  the  disease,  he  shall  he  returned  to  such  jail. 

p  .  (1716.)  Sec.  25.  If  the  person  so  removed  shall  have  been  committed  by  order  of 

moved  to  be  re-    ^ny  court,  or  under  any  judicial  process,  the  order  for  his  removal,  or  a  copy  thereof, 

turned,  and  sot   attested  by  the  presiding  member  of  said  board  of  health,  shall  be  returned  by  him, 

to  be  considered  ^^^^  ^^^  doings  thereon,  into  the  office  of  the  clerk  of  the  circuit  court  for  the 
88  naving 

escaped.  county;  and  no  prisoner,  removed  as  aforesaid,  shall  be  considered  as  thereby  hav- 

ing committed  an  escape. 

31.  Small-pox  in  a  poorhonse — On  the  outbreak  in  a  county  pooi'house  or  in 
the  vicinity  thereof  of  any  pestilence  or  contagious  disease  likely  to  endanger 
the  health  of  persons  supported  at  the  poorhouse,  the  superintendents  are  by 
section  1717  required  to  remove  to  some  other  suitable  place  any  or  all  of  the 
persons  there  supported  until  they  can  safely  be  returned  or  otherwise  be  dis- 
charged.    Section  1717  is  as  follows : 

Whensuperin-  (1717.)  SEC.  26.  Whenever  any  pestilence  or  contagious  disease  shall  break  out  in 
tendents  of  poor  any  county  poorhouse  in  this  State,  or  in  the  vicinity  thereof,  and  the  physician  to 
P8^er8°from  such  county  poorhouse,  or  such  other  physician  as  the  superintendents  may  con- 
poorbouaes.  suit,  shall  certify  that  such  pestilence  or  disease  is  likely  to  endanger  the  health  of 

the  persons  supported  at  such  poorhouse,  the  superintendents  of  such  county  poor- 
house shall  cause  the  persons  there  supported,  or  any  of  them,  to  be  removed  to 
some  other  suitable  place  in  the  same  county,  there  to  be  maintained  and  provided 
for  at  the  expense  of  the  county,  with  all  necessary  medical  attendance  and  care, 
until  they  can  safely  be  returned  to  such  poorhouse,  or  otherwise  discharged. 


In  July,  1877,  the  Michigan  State  Board  of  Health  passed  a  resolution  advising  and  requesting  all 
boards  of  health  to  offer  every  year  free  vacclnaton  with  bovine  virus  to  every  child  not  previously 
vaccinated  and  to  all  other  i)er3ons  jiot  vaccinated  within  five  years.  The  resolution  was  then, 
and  has  since  been  widely  distributed  throughout  the  State.  This  tract  more  fully  sets  fortli  the 
importance  of  vaccination,  and  other  means  for  the  prevention  and  restriction  of  small-pox. 

It  is  hoped  that  local  boards  of  health,  newspapers,  and  all  public-spirited  persons  will  aid  in 
spreading  the  information  lierein  contained.  It  is  recommended  that  every  local  board  of  health 
secure  copies  of  this  tract,  and  place  one  copy  in  every  household  within  its  jurisdiction.  Although 
large  numbers  are  distributed  by  the  State  Board  of  Ileallh,  its  distribution  will  not  reach 
every  household,  but  to  facilitate  this  the  State  Board  has  secured  electrotype  plates  of  this 
tract;  in  English,  from  which  coiiies  can  cheaply  be  reprinted.  Copies  of  this  tract  may  be  had 
of  W.  S.  George  &  (Jo.,  Lansing,  Michigan,  at  the  following  terms,  cash  to  accompany  order: 

lOOcopiesfor S3  00  i     400  copies  for S7  00 

200      "         "    4  .W       600      "         "    8  00 

300      "         ••   6  00  I  1,000      "         "    14  00 

A  copy  of  this  document  may  be  obtained  by  any  person  in  Michigan  by  addressing  the  Secretary 
of  the  State  Board  of  Uealth,  Lansing,  Michigan 


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GAYLAMOUNT 

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MonufacluttJ  by         , 
eAYLORD  BROS.  I«c. 
Syracux,  N.  Y. 
Stockton,  C«lif.  r 


I 


L5e 

^:qi?3  1582 

Mchigan,     otate  board   of  health. 

Prevention  r-nd  restriction   of 
sn.6ll-pox. 


SEP  7 


r  ,*  (5 


^*  U.  BINDitii^y 


RCIS3 


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